RECOVERY FROM BELL'S PALSY LESS CERTAIN FOR WOMEN WHO DEVELOP THE DISORDER DURING PREGNANCY

University of Pittsburgh School of Medicine ear, nose, and throat specialists find that women afflicted with Bell's palsy who progress to a complete paralysis have significantly less satisfactory recovery than the non-pregnant population

Bell's palsy is paralysis, usually unilateral, of the facial muscles caused by dysfunction of the 7th cranial nerve; probably due to a viral infection. Medical researchers have long speculated that pregnant women are more susceptible to the disorder than the general population. Theories include the possibility that tissue edema in pregnancy causes mechanical compression of the facial nerve in the fallopian canal, noting the correlation between the timing of the maximal interstitial fluid volume content and the peak incidence of Bell's palsy. Other theories include an association with higher levels of progesterone and estrogen in pregnancy, toxemia of pregnancy, and the higher overall incidence of neuropathies found in the expectant mother.

Incidence of the condition in pregnant women has been much studied. However, little research had been conducted on the recovery from Bell's palsy until the Pittsburgh study. The study was carried out by Grant S. Gillman MD, Barry M. Schaitkin MD, Mark May MD, and Susan R. Klein MA, CCC-A, all from the Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA. The results of their findings were presented April 26 at the annual meeting of the Triological Society, being held April 26-28 at the Marriott's Desert Springs, Palm Desert, CA.

Methodology: A retrospective chart review was carried out on all patients seen with a diagnosis of Bell's palsy of pregnancy over a 30 year period (1965-1995). One hundred and seventeen women were identified who developed facial paralysis during pregnancy or the post-partum period (within seven days of delivery), of whom 100 were diagnosed with Bell's palsy.

After review and additional medical record screening, 78 episodes in 77 women (one woman developed simultaneous bilateral facial paralysis) were selected. Recovery outcomes for the study group were compared to a randomly selected group of patients with Bell's palsy consisting of non-pregnant females (15-40 years of age), women of all ages, men (15-40 years of age), and men of all ages.

Recovery from Bell's palsy was categorized as satisfactory (according to House-Brackmann grade I-II) or unsatisfactory (House-Brackmann grade III-IV). A two-tailed Fisher exact test was used to stastically analyze differences between groups.

Results: The researchers found that 52 percent of the women whose facial palsy progressed to a complete paralysis within ten days of onset recovered to a satisfactory level as compared to a 77-88 percent in the control group. Additional findings include:

Of the 16 pregnant patients with complete paralysis, 11 received oral steroids as a treatment option. Of that group of 11, five had a satisfactory outcome and recovery, six did not. In patients not receiving oral steroids, 55% had a satisfactory outcome, 45% did not experience recovery.

All patients seen in this study with an incomplete facial paralysis during pregnancy and early post-partum period had a satisfactory recovery. This is with the same rate found in the control group.

Nine, or 12 percent, of the study group went on to develop a recurrence of Bell's palsy later in life. This was consistent with the recurrence rate found in the general population.

The researchers suggest that physicians of women who are subject to complete facial paralysis during pregnancy advise their patients of the greater potential for incomplete recovery.

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Contact Ken Satterfield at 703-519-1563 (until 4/22) or 760-776-8503 (4/22-4/29) for an interview with Dr. Gillman or additional information.